| NPI | 1114924677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: SC 38328) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: GA 074240) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2022-09-13 |